Title : Challenges and methods to improve orthopaedic theatre efficiency and maintain standards of care during the Covid-19 Pandemic: What have we learned and how can we improve?
Abstract:
Introductions
The Covid-19 pandemic has had a major global impact on theatre time utilisation and efficiency within trauma & orthopaedics especially with time sensitive procedures. This has led to increased delays in surgical management affecting outcomes aside from just length of stay including patient morbidity and mortality. Gross number of operative trauma cases has remained fairly static outside of lockdown periods and so the need for adaptability and implementation of ever changing protocols are necessary in the face of the dynamic nature of the pandemic to ensure patients receive optimum management in a safe and timely manner. This review aimed to identify and highlight strategies, management protocols and examples of excellence that have been employed to optimise theatre efficiency within orthopaedic practice that can be applied to pan-surgical specialties and theatre environments.
Methods
A systematic literature search was conducted using PubMed identifying relevant research articles containing key words: ‘Covid,’ ‘Theatre Efficiency,’ ‘Trauma’ and ‘Orthopaedic’. Duplicate studies were excluded gleaning 20 studies. Data was sorted according to pre-set inclusion and exclusion criteria. Original articles discussing orthopaedic operating and theatre time efficiency in the Covid-19 pandemic, written in the English were included. Editorials, Case reports and articles involving other surgical specialities were excluded giving a final cohort of 12 studies.
Results
Our search yielded 12 articles meeting the inclusion criteria. 6 were observational studies, 3 systematic reviews and 3 expert opinion reports. All the reports were published in the Covid pandemic era (between 2020 – 2021). The data obtained was presented mainly as a narrative review. Research identified the importance of ensuring safety measures are protocolised and urgently achieved. Furthermore, the literature consistently underlines the value of regular holistic MDT style communication to discuss and find solutions to challenging arising problems, disseminate information and regularly update and implement such protocols as the pandemic has progressed. This has implications for healthcare practitioners to be successful in delivering required care to achieve a timely passage to theatre and avoid delays and cancellations. The Productive Operative Theatre Initiative, published by NHS England in June 2020 as well as British Orthopaedic Association Covid-19 standards have been utilised with good outcomes across many UK based hospital trusts to ensure theatres run more productively and efficiently as the actual operative time available on a list is even more finite than usual. In the UK this has results in some research showing improved outcomes between the 2 lockdown periods where lessons were learned and better practice implemented.
Conclusion
Orthopaedic theatre utilisation and efficiency has been reduced due to importance of adopting multiple ever changing safety measures during the Covid Pandemic. The need to educate relevant staff and maintain these measures as well as provide efficient care remains a constant challenge. Guidance advocated by the BOA, The American College of Surgeons and NHS England are valuable adjuncts to avoid loss of valuable theatre time and ensure they smoothly with the aim to improve patient outcomes.
